IABP in acuteHF

Introduction Intra-aortic balloon pump (IABP) remains a widely available and easily deployable form of temporary mechanical circulatory support for patients with cardiogenic shock. While large randomized trials in myocardial infarction–related shock failed to demonstrate a survival benefit, emerging evidence suggests that in heart failure–related cardiogenic shock (HF-CS) — a distinct clinical entity characterized by progressive pump failure rather than acute coronary occlusion — IABP may provide rapid hemodynamic stabilization, improve tissue perfusion, and serve as a bridge to recovery or therapies. Methods We retrospectively studied a cohort of 13 patients from 2022–2025 who underwent IABP insertion for cardiogenic shock complicating HF-CS, at a cardiac intensive care unit (CICU). Patient variables immediately before IABP insertion, and at 24 and 48 hours, were compared using independent samples T-test. Baseline: The cohort comprised 13 patients with a mean age of 58 ± 18 years; 92% (n = 12) were male, 15% (n = 2) had a previous myocardial infarction, 46% (n = 6) had chronic heart failure,. 23% (n = 3) had an implantable cardioverter-defibrillator (ICD), and 7.7% (n = 1) had peripheral arterial disease (PAD). At admission, SCAI class distribution was B 7.7% (n = 1), C 76.9% (n = 10), and D 15.3% (n = 2). Median lactate at admission was 2.1 mmol/L [1.65–4.8]. All IABPs were inserted at the CICU, except for one. Results Median mean arterial pressure (MAP) remained stable from 75 mmHg [63–83] before IABP to 70 mmHg [64–80] at 24 hours (p = 0.70), but increased to 83 mmHg [72–90] at 48 hours (p = 0.10), while heart rate decreased from 100 bpm [IQR 83–128] at baseline to 93 bpm [78–107] at 24 hours (p = 0.033) and 87 bpm [ 82–99] at 48 hours (p = 0.116). Central venous oxygen saturation increased from 50% [33–61] to 60.5% [56–68] at 24 hours (p = 0.021) and 69% [55–74.5] at 48 hours (p = 0.012). Markers of end-organ function also improved over time: creatinine declined from 1.83 mg/dL [1.26–2.68] at baseline to 1.75 mg/dL [1.09–2.48] at 24 hours (p = 0.158) and 1.41 mg/dL [0.98–2.12] at 48 hours (p = 0.028). Concomitantly, vasoactive requirements decreased: norepinephrine doses were reduced from 0.59 µg/kg/min [0.14–0.89] before IABP to 0.33 µg/kg/min [0.14–0.60] at 24 hours (p = 0.043) and 0.16 µg/kg/min [0.02–0.25] at 48 hours (p = 0.028). Eleven patients (85%) were classified as IABP responders and were successfully bridged to either recovery (n = 7), left ventricular assist device implantation (n = 2), or heart transplantation (n = 2). IABP support failed in two patients (15%), who required escalation to extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock. Conclusions In our institutional experience, IABP use in HF-CS led to a rapid improvement in hemodynamic, clinical and laboratory parameters, reflected by reduced vasopressor requirements and improvements in MAP, creatinine levels, lactate and SvCO₂.